Provider Demographics
NPI:1538390141
Name:OPTIONS RESIDENTIAL, INC
Entity type:Organization
Organization Name:OPTIONS RESIDENTIAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-226-7120
Mailing Address - Street 1:2105 W BURNSVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4237
Mailing Address - Country:US
Mailing Address - Phone:952-564-3030
Mailing Address - Fax:952-564-3038
Practice Address - Street 1:2105 W BURNSVILLE PKWY
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4237
Practice Address - Country:US
Practice Address - Phone:952-564-3030
Practice Address - Fax:952-564-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1049866-1-ADC261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN162386OtherUCARE
MNA208452100Medicaid